Midterm Flashcards
Health Teaching
- Focused form of instructional dialogue used in client-centred relationships
- The purpose is to provide clients and families with the knowledge and life skills needed to make good decisions, slow or prevent disease progression and mortality, and promote the highest possible quality of life
- The goal is to help clients assume as much responsibility as possible with personal self management of their health
goals of patient education
- Maintaining, restoring and promoting health
- preventing illness
- Optimizing quality of life with impaired functioning
domains of learning
cognitive
affective
psychomotor
basic learning principles
motivation to learn
- addresses the patients desire or willingness to learn
ability to learn
- depends on physical and cognitive abilities, developmental level, physical wellness, thought processes
learning environment
- allows a person to attend to instruction
motivation to learn
- social motives: motivation to engage with others
- task mastery motives: “I want to learn how ___”
- physical motives: “I want to improve/maintain my health”
Teaching Process: Assessment
Nurses need to assess all factors that influence content, ability to learn, and resources available.
- Learning needs
- Ability to learn
- Motivation to learn
- Teaching environment
- Resources for learning
Teaching Process: Nursing Diagnosis
Examples:
- Ineffective health maintenance
- Health-seeking behaviours
- Impaired home maintenance
- Deficient knowledge
- Ineffective therapeutic regimen management
- Ineffective community therapeutic regimen management
- Ineffective family therapeutic regimen management
Teaching Process: Planning
Determine goals and expected outcomes that guide the choice of teaching strategies and approaches with a patient.
- Developing learning objectives
- Setting priorities
- Timing
- Organizing teaching material
- Maintaining attention and promoting participation
- Building on existing knowledge
- Selecting teaching methods and resources
- Writing teaching plans
Teaching Process: Implementation
- Maintain learning, attention and participation
- Select teaching approach.
- Incorporate teaching with nursing care.
- Implementing teaching methods
- Recognize cultural diversity.
- Use different teaching tools.
Teaching Process: Evaluation
- Necessary to determine whether the patient has learned the material
- Helps to reinforce correct behaviour and change an incorrect behaviour
- Success depends on the patient’s performance of expected outcomes
- Measurement methods (can they demonstrate the skill, can they repeat back in their own words what they understood)
- Patient expectations
- Documentation
what is health
- Historically, being healthy was an objective concept that meant stability and balance, the absence of disease and symptoms
- World Health Organization has defined health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”
- “A structural, functional and emotional state that is compatible with effective life as an individual and as a member of family and community groups”
what is wellness
The WHO’s new definition of wellness is the optimal state of health of individuals and groups
Two focal concerns:
- The realization of the fullest potential of an individual
- The fulfillment of one’s role expectations
- Subjective
what is disease
The physiological deviation from normal, which is objective or measurable
“Implies a focus on pathological processes that may or may not produce symptoms and that result in a patient’s illness”
what is illness
The experience of living with a disease
It is subjective, depending on the personal experience of associated symptoms, suffering, or distress
Parsons Sick Role Theory
- A set of behavioural expectations about how a sick person is supposed to behave is built into our social system
- The sick role has two major rights and two major duties
- two major rights
1) The sick person is typically exempt from responsibility for the illness condition
2) The sick person is temporarily exempt from performing normal social role behaviours - two major duties
1) The sick person has the duty to try to get well and resume normal social roles as quickly as possible
2) The sick person has the duty of actively seeking technically competent help
criticisms of parsons sick role theory
- Focuses on acute illness rather than chronic illness
- Limited to selected physical conditions, ignoring psychosocial conditions
- Medico-centric with a professional bias against lay, self-care behaviour
- Decontextualized, failing to consider the influence of aspects of social location such as culture, class, and gender
3 fundamental ideas of wellness
- Wellness domains are interrelated
- Wellness seems to ebb and flow within and among domains
- Patient not nurse is responsible for making wellness choices
wellness domains
- emotional
- intellectual
- occupational
- physical
- sexual
- spiritual
- environmental
- social
Special populations considerations: Disability
Medical model
- Health care provider is considered powerful and the client is a victim, unable to function normally, at a psychological loss without the health care provider
Disability model
- Views the client as a result of a tragedy to be adjusted to and overcome, oppressed because of inability
Social model
- Focuses on the limits that have been placed on the client based on the space (environment, space) where the client interacts
Special population considerations: gender and sexuality
- Substance and alcohol abuse more prevalent among LGBTQ individuals
- Gay, lesbian, or bisexual people can experience 2-3 times greater chances of anxiety and mood disorders
- LGBTQ population have challenges to access of health care: discrimination, lack of knowledge, ignorance, assumptions during assessment, culturally unsafe behaviours, inequitable access
- Increased stress and mental health issues due to lack of respect, stigma, substance abuse, lack of parental/family support
Special population considerations: Indigenous People
- Indigenous perspectives often compared with Western approaches
- Appropriate nursing care of Indigenous peoples are strengths based, focused on relationships and integrating culture
- Nursing care is based on holism: the balance of physical, spiritual, emotional and mental balance
population health
- Improving the social determinants of health from the perspective of a nation
- Varied distribution of resources and socioeconomic status which results in health inequities
- Living in poverty increases incidences of poor health, chronic disease
- Healthcare system only one way to keep population healthy
- Other determinants of health play a much bigger part in population health
health inequities
Avoidable, unjust, and unfair systematic differences in health status within the population. Socially produced and modifiable
health inequalities
Identified differences in health status of individuals, groups, or populations. These differences are based on measurable data, such as biological, socioeconomic factors, individual behaviours, physical and environmental, early childhood development and healthcare access
health disparities
Measured outcomes caused by health inequities closely linked to determinants of health, and affecting diverse groups who have been discriminated against or excluded (unequal burden of diseases on discriminated populations that experience health inequities)
primary prevention
aimed at protecting a person, just in case
secondary prevention
aimed at detecting disease early
tertiary prevention
restoring function or rehabilitating to potential
transtheoretical model
- Stages of health behaviour change
- Used in assessing or examining health promotion strategies
- Outlines 10 cognitive process and 6 stages of behaviour change
- Individuals will weigh the pros and cons of a behaviour to make a decision about that behaviour
1) Precontemplation - lack of desire to talk about behaviour and resistance to change
2) Contemplation - considering pros and cons of behaviour, intends to change behaviour within 6 months (“i know i should quit smoking but i don’t know how”
3) Preparation - active process of planning to change behaviour in the next month, a plan is made (“I have joined a gym and bought gym clothes”)
4) Action - significant changes have been in effect for 6 months, goals are made (“i havent smoked in 6 months”)
5) Maintenance - individuals continued efforts to maintain healthy behaviour, prevent relapse
6) Termination - individual has self efficacy and risk of temptation is not a problem. Healthy behaviour is now automatic
health promotion strategies
Individual → population focused Ottawa Charter for Health Promotion: - Build healthy public policy - Strengthen community action - Create supportive environments - Develop personal skills - Reorient health services
socialized medicine
Canada’s publicly funded universal health insurance system designed to ensure that all residents have reasonable access to medically necessary hospital and physician services. Unofficially, socialized medicine may be referred to as Medicare
approaches to healthcare in Canada
Medical
Behavioural
Socioenvironmental
medical approach to healthcare
Focus was on curing diseases
Medical interventions were emphasized
Health care was reactive; did not incorporate proactive approaches for disease prevention and health promotion
Socialized medicine introduced in 1947
behavioural approach to healthcare
A shift from medical to behavioural began in 1970’s
A New Perspective on the Health of Canadians (Lalonde Report)
Promoted individual responsibility for health
Focus on health promotion/disease prevention
The Epp Report: Key Components
1) Assessing the health status of disadvantaged groups and reducing inequities
2) Detecting and managing chronic disease
3) Identifying disease that were preventable and focusing on prevention
4) Enhancing people’s abilities to cope
Ottawa Charter for Health Promotion Strategies:
1) Build public health promotion policies at all levels of government
2) Create and maintain supportive physical, social, cultural, spiritual, and economic environments
3) Strengthen community action to achieve better health via priority setting and responsible decision-making inclusive of diligent assessment, planning and implementation
4) Develop personal skills to enable preparation for all life stages, including illness and injury
5) Redefine and/or reorient health services to better meet the individual and community health needs
Socio Environmental Approach to Healthcare in Canada
- Builds on the behavioural perspective that humans’ chosen interaction with biology, lifestyle, environment, and health care (or access to care) is a legitimate factor in determining health and health outcomes
- Social context refers to family and community environment (social support network, housing and education, social status) in which we live and interact
- Environmental context refers to human-built environments, encompassing: air, food, and water quality; communication and entertainment technology; transportation; sedentary vs. active lifestyles; food availability; and, cultural components of health
1984 Healthcare Act
- Sets out criteria, conditions, and national standards for insured health care services that provinces and territories must meet to receive federal funding
- Possibly most important landmark legislation in support of Canadian health care because it mandated universal health care coverage for all Canadians
- Replaced Hospital Insurance and Diagnostic Services Act of 1957 and the Medical Care Act of 1966
5 pillars of Canadian healthcare
- public administration
- comprehensiveness
- university
- portability
- accessibility
public administration
Each provincial and territorial health insurance plan must be administered and operated on a not-for-profit basis by a public authority
comprehensiveness
The health-care insurance plan of a province or territory must cover all insured services provided by hospitals, physicians, or dentists and be available to all provincial or territorial residents with equal opportunity.
universality
All insured residents are entitled to the insured health services provided by their respective provincial or territorial health insurance plan on uniform terms and conditions
portability
Residents moving from one province or territory to another continue to be covered for insured health services by their home jurisdiction during any waiting period
accessibility
Protects all insured people from extra charges for health care and are guaranteed reasonable access to insured hospital, medical, and surgical-dental care on uniform terms and conditions without discrimination on the basis of age, health status, or financial circumstances
Points of care
Primary
- The element that focuses on health care services, including health promotion, illness and injury prevention, and the diagnosis and treatment of illness and injury.
- Family doctor, health unit, public health
Secondary
- Involves diagnosis and treatment of health challenges of varying complexities by specialists.
- Physician specialist (ex: dermatologist), community hospital, naturopath
Tertiary
- Tertiary health care is specialized consultative care involving dedicated supports and resources usually based on a referral from primary or secondary health care providers.
- Acute care hospital, palliative care
Quaternary
- Quaternary care is distinguished by the difference in type and availability of specialized care provided.
- Acute care hospital
nursing practice in Canada
- Currently, baccalaureate degree as entry to registered nurse (RN) practice is required by all provinces and territories, expect Quebec
- In addition to RN practice, other roles include: Registered practical nurse (RPN), Licensed practical nurse (LPN), Registered psychiatric nurse (RPN)
- Scope of RN and RPN’s differ and are outlined clearly by provincial and territorial licensing bodies
why did health care reform happen?
- Population, healthy ecology, and prevalence of chronic health challenges are among aspects challenging current health care system.
- Growing concern about publicly funded health care system and if it can continue to meet changing needs of Canadians.
- Pan-Canadian Strategy for Client-Oriented Research (SPOR) created to “support evidence informed transformation and delivery of more cost-effective and integrate health care.”
primary care reform
- Changes to primary health care are ongoing
- Key changes include: a shift from individual health providers to teams; telehealth
- Reliant on adequate supply of human resources and up-to-date technology
secondary care reform
- Shift from institutional to community based
- Providing the best care in the most client-appropriate environment while managing health care more efficiently (e.g., changing patterns of care from institutional to community-based)
- Currently entering into a phase with provinces making bilateral agreements with the federal government rather than health accords
conventional model of health and disease
Key element is the interaction of the individual’s susceptibility (or resilience) on one hand, and risks (or protective factors) on the other
Susceptibility (or resilience) is grounded in individual characteristics such as sex, age and genetics
Risks (or protective factors) range from pathogens and poisons to environmental conditions
host and agent
Characteristics which increase or decrease my vulnerability constitute host susceptibility; the characteristics of risk such as the virulence of a strain of influenza constitute agent potential to damage health
epidemiology
the science of explicating the causes and variations of disease incidence, is likewise based on the host/agent model
analysis of risk
- Risk factor analysis requires, because it is about probabilities, populations of people with and without a disease of interest and populations who have and have not been exposed to presumed risks
- Statistical associations are about a set of observations or a population, not a single event or person
associations, risks are not causes
- Risks are therefore probabilities, statistical associations with a health outcome
- An association or probability is NOT a cause; it’s a measure of amount of risk
- Smoking is risky because more smokers than non-smokers will get lung cancer or have heart attacks
- But we do not know how smoking will affect a given individual’s health even though we do know that a group of smokers, as a group, will be less healthy than a group on non-smokers
shift away from conventional model: timeline
- Publication in 1974 of A New Perspective on the Health of Canadian (Lalonde)
- The 1986 report Achieving Health for All: A Framework for Health Promotion (Epp)
- Also in 1986, The Ottawa Charter
- In 1997, statement by the Canadian Federal, Provincial and Territorial Advisory Committee on Population Health
